“An exploration of the experiences of emergency nurses’ workplace stressors and their coping strategies”

Miss Oluwadunsin Adesina1, Dr Anita De Bellis2, Dr Katrina Breaden3

1 Miss Oluwadunsin Adesina, Faculty of Medicine, Nursing & Health Sciences, Flinders University, GPO BOX 2100, ADELAIDE  SA  5001, Australia, ades0007@flinders.edu.au
2 Dr Anita De Bellis, Faculty of Medicine, Nursing & Health Sciences, Flinders University, GPO BOX 2100, ADELAIDE  SA  5001, Australia
3 Katrina Breaden, Faculty of Medicine, Nursing & Health Sciences, Flinders University, GPO BOX 2100, ADELAIDE  SA  5001

Australia

The challenges and stressors that nurses face in their workplaces can differ from one nursing specialty to another depending on the context of their work. A considerable amount of research has examined stress and coping in general; however, little of this has focused on emergency nurses, who are continually exposed to a wide range of workplace stressors in their daily nursing practice. Failure on the part of emergency nurses to adequately cope with and resolve these stressors can lead to compassion fatigue, burnout, post-traumatic stress disorder (PTSD) and a high attrition rate among emergency nurses.

The aim of the study was to explore emergency nurses’ experiences of stress in their workplace and the coping strategies they use to manage these stresses. Based on the review of the literature, Interpretive Description (ID) was adopted and used for the purposes of answering the research question. The study was conducted on willing emergency nurses who were members of the College of Emergency Nurses Australasia (CENA), with data collected through audiotaped semi-structured interviews via telephone. Ten participants answered questions about their experiences of stress, how they were affected by stress and the coping strategies they used to cope with stress. Five themes emerged with a number of associated subthemes.

The findings showed that emergency nurses enjoyed emergency nursing because of patient presentation, the team work, providing and delivering patient care and the satisfaction they derived from being an emergency nurse. Regarding the causes of stress for emergency nurses, these were found to include work conditions, violence and aggression, death and dying and interpersonal relationships. The third theme revealed the physiological and physical effects of stress in association with the effects of workplace stress on emergency nurses’ professional and personal life.

To cope with their workplace stresses, emergency nurses used debriefing as an important strategy and their perceived level of support from their organisation contributed to how they coped with stress. Emergency nurses also relied on their personal coping mechanisms.  The last theme revealed that emergency nurses’ personalities and use of a cognitive approach made a substantial difference to how they were affected by and coped with workplace stress.

The discussion interpreted the findings in relation to the research question. The discussion centred around the contemporary stresses of emergency nurses,  compassion fatigue being a result of workplace stress, the importance of coping with stress, and resilience as an attribute of coping. Finally, the implications of the findings for emergency nurses, practice and management were outlined and recommendations were made for education and further research.

Biography

My Name is Oluwadunsin (Dunsin) Adesina. I graduated from Flinders University Adelaide and I am a registered nurses that works at the Royal Adelaide Hospital I have been an emergency nurse for six years. I decided to pursue an Honours Degree after my graduation from Flinders University and my research question was based on my interest in knowing what emergency nurses found stressful and their coping strategies for these stressors.I have a graduate diploma in emergency nursing and I have been involved in the resuscitation team of the Royal Adelaide Hospital.  i have also had the opportunity to be a leadership position at work and being a member of a very multi-disciplinary team.

Is there a doctor on-board? A personal account of a mid-flight emergency

Karen Thompson1

Emergency Department North West Regional Hospital, Burnie, TAS, 7320 | RN Grad Dip (Emergency Nursing) Grad Cert (CritCare, Rural and Remote Health)  Certified Instructor (Non-violent Crisis Intervention) BN

Historically, international travel was the privilege of the wealthy, but the advent of discounted airfares in recent times has brought overseas travel within the reach of the average Australian. Although intrinsically remote with great distances between localities, our country is also extrinsically remote in its isolation from other countries. Consequently, a nurse may find his/herself practising in challenging and/or remote situations, with scant support. The following talk is a personal account of my experience of practicing in a very confronting environment during a mid-flight emergency. The presentation is underpinned by research on remote nursing and obstetric emergencies and summarised with my reflections, experiential learning and recommendations.

Halfway home from a family holiday to Fiji I had just put my book down and closed my eyes, when a man in the opposite row called for help. His wife – Sophie*- was lying awkwardly across the seats and floor in the clonic phase of a seizure. Given her obvious state of pregnancy, I immediately suspected eclampsia, an obstetric emergency.  Practising my DRABC I noted she was in imminent danger from surrounding fixed structures and at risk of positional asphyxia, so her husband assisted me to re-position her as the call went out for a “doctor on board”.

Her unresponsive post-ictal state indicated a GCS of 5 at best (E1V3M1) causing me further concern over the patency of her airway, so I enlisted the help of two men, who identified themselves an obstetrician and a urologist, to carry Sophie to the galley.  I turned to resume my seat, but when they discovered I was a remote emergency nurse, I was asked to stay, primarily because neither had cannulated for over ten years!

While conducting Sophie’s secondary survey, we discovered that she had many risk factors for pre-eclampsia, including having the condition in a previous pregnancy and hypertension during this pregnancy. At this point, my talk will detail Sophie’s management, including intravenous drug therapy, fluid resuscitation and airway management.

Most emergency nurses will find ourselves, at some point, practicing in challenging and/or remote situations.  However, I confess being 30000ft above the Pacific Ocean with a severely hypertensive post-ictal woman and limited medical supplies the most isolated and challenging situation of my career. Not to mention the almost surreal experience of sitting on the galley floor, managing the patient’s airway while the plane landed!

Upon reflection, I learned much from this unusual experience. Firstly, I was reassured that I was equipped to deal with a highly challenging situation. Secondly, it reminded me of how resourceful one becomes when working in remote areas and the intestinal fortitude one develops. It also made me realise that a good nurse is never off duty; we can leave the problems behind at the end of a shift, but we never leave the caring shut up in our locker. Finally, it reinforced my personal belief that all nursing students should experience remote placement time as part of the Bachelor of Nursing degree.

References

Australian Resuscitation Council http://resus.org.au/guidelines/flowcharts-3/  accessed 14/7/16
Central Australian Rural Practitioners Association, 2009, CARPA Stamdard Treatment Manual 5th Ed,  Alice Springs, Central Australian Rural Practitioners Association
Curtis, K & Ramsden, C 2015, Emergency and trauma care : For nurses and paramedics, Chatswood, NSW : Elsevier Australia, 2016. 2e Australia and New Zealand edition.
Duley, Lelia. “Pre-eclampsia and the hypertensive disorders of pregnancy.” British Medical Bulletin 67.1 (2003): 161-176
Duckitt, K. and Harrington, D., 2005. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. Bmj, 330(7491), p.565.
Smith, JD 2007, Australia’s rural and remote health : A social justice perspective, Croydon, Vic. : Tertiary Press, 2007. 2nd ed.

Biography

Karen has a varied background over the past 35 years, beginning her nursing career as a mental health nurse under the “old system” in the early 1980s. She returned to study at the University of Canberra in 2000, to complete a Bachelor of Nursing. She has worked in the emergency department for over seven years after extended stints in remote health and ICU nursing. She has also practised in women’s health, general practice and drug and alcohol programs. Karen has recently diversified into teaching as a certified instructor in non-violent crisis intervention and works as a sessional teacher of the Diploma of Nursing at TasTAFE. Her other qualifications include Grad Certs in both Critical Care and Rural and Remote Health, as well as a Grad Dip in Emergency Nursing and expects to complete her Masters of Clinical Nursing degree in October 2016. Karen’s clinical interests are education, crisis intervention and an intense fascination with the pathophysiology of trauma, particularly brain injury. Her personal interests include a passion for travel and study of languages, animal welfare, playing netball, volleyball and softball, loud rock music and maintaining an organic mini-farm. Not least, she enjoys spending time with her family and spoiling her four grandchildren, and her greatest supporter through all her academic achievements is her husband David.

Calm your farm! De-escalation strategies for potentially violent situations in the emergency department

Karen Thompson1

1 RN, Grad Dip (Emergency) Certified instructor (Non-violent Crisis Intervention) | North West Regional Hospital, Burnie TAS 7320 karen.thompson@dhhs.tas.gov.au

A common public perception of nursing is “the caring profession”, yet ironically, nurses are at ever-increasing risk of exposure to violence in the workplace, and the emergency department is identified as a high risk environment. Indeed, a study conducted by in 2006 found that 63.5% of Tasmanian nurses reported being subjected to some form of work-place violence in the previous four weeks and it is documented as a major stressor contributing to challenging working environments and high turnover.

Today, I’m going to discuss a situation which is challenging from both an environmental and personal perspective, how one challenging situation generated another and the strategies employed to address both.

Obviously action was needed to address this problem and research led to the adoption at my workplace of a program known as Non-violent Crisis Intervention (NVCI). In a perfect world this would seem to be the answer, however the introduction of the program created challenges in itself. Once the preliminary structure of the program was in place, all staff were emailed and either appointed or invited to attend a session – a method which created immediate resistance in many quarters. The primary concern expressed by many nurses was that they would be engaging in some form of hand to hand combat, generated by the historical mindset that Code Black = forcible take-down. They, quite reasonably pointed out that these situations were outside their scope of practice.

Paradoxically this unfavourable situation provided unexpectedly positive outcomes, as it challenged me to find cohesion and acceptance of the program. I used servant leadership theory to support pace-setting leadership as I assured my colleagues that I too am disinclined to be wrestling with aggressive individuals

A full-day workshop format was developed and with no pre-reading or preparation required, staff attend with, hopefully, an open mind, although this is often not the case. During the workshops, interactive learning sessions are presented, covering stages of agitation, the verbal escalation continuum and identifying precipitating factors for deteriorating situations. We focus on understanding and intervening appropriately to certain behaviours rather than making the individual cease the behaviour. Role playing and activities complement the sessions, enabling the staff to experience the situation from the perspective of the person in crisis and learn and practice personal safety techniques. All sessions are underpinned with the message of Care, Welfare, Safety and Security of all, reminding staff at all times that the acting-out individual is a person in crisis; they have no control so the staff member must maintain control of him/herself.

Given that increasingly violence is a global problem – think road-rage, trolley-rage and similar phenomena – the challenge of being faced with violence in the workplace is not going to disappear overnight. As more staff complete the NVCI program, with overwhelmingly positive feedback, the objectives that staff will be equipped with advanced de-escalation skills and more likely to report incidents, leading to a safer workplace environment, are being met. This has generated several recommendations, primarily that NVCI training be adopted for all staff – clinical and non-clinical – as part of mandatory credentialing, and that the name be changed from Code Black Training to NVCI Education

References

Cummings, G, 2012, Editorial: Your leadership style – how are you working to achieve a preferred future? Journal of Clinical Nursing, 21, 3325-3327
Farrell, G A, Bobrowski, C B A, Bobrowski, P. 2006, scoping workplace aggression in nursing: findings from an Australian study, Journal of Advanced Nursing, 55(6):778
Goleman, D 2000, Leadership that gets results, Harvard Business Review, March-April, 78-90.
Greenfield, D. (2007). “The enactment of dynamic leadership.” Leadership in Health Services 20(3): 159-168.
Mannix J, Wilkes L & Daly J (2015) ‘Aesthetic leadership: Its place in the clinical nursing world’, Issues in Mental Health Nursing, Vol 36, No 5, pp 357-361
Stanley, D (2011), Clinical Leadership: Innovation into action, Melbourne: Palgrave Macmillan, pages 265-275

Biography

Karen has a varied background over the past 35 years, beginning her nursing career as a mental health nurse under the “old system” in the early 1980s. She returned to study at the University of Canberra in 2000, to complete a Bachelor of Nursing.  She has worked in the emergency department for over seven years after extended stints in remote health and ICU nursing. She has also practised in women’s health, general practice and drug and alcohol programs. Karen has recently diversified into teaching as a certified instructor in non-violent crisis intervention and works as a sessional teacher of the Diploma of Nursing at TasTAFE. Her other qualifications include Grad Certs in both Critical Care and Rural and Remote Health, as well as a Grad Dip in Emergency Nursing and expects to complete her Masters of Clinical Nursing degree in October 2016. Karen’s clinical interests are education, crisis intervention and an intense fascination with the pathophysiology of trauma, particularly brain injury.Her personal interests include a passion for travel and study of languages, animal welfare, playing netball, volleyball and softball, loud rock music and maintaining an organic mini-farm. Not least, she enjoys spending time with her family and spoiling her four grandchildren, and her greatest supporter through all her academic achievements is her husband David.

Workplace violence in the Emergency Department in the Kingdom of Saudi Arabia

Waleed Alshehri1, Virginia Plummer2, Paul Jennings3

1 Monash University, School of Nursing and Midwifery (waleed.alshehri@monash.edu)
2 Monash University, School of Nursing and Midwifery (virginia.plummer@monash.edu)
3 Monash University, Department of Community Emergency Health and Paramedic Practice (paul.jennings@monash.edu)

Background: Workplace violence (WPV) occurs in any industry or occupation, but the health industry is at high risk. Healthcare professionals are at increased risk of WPV because they are working with the public, sometimes work with unstable or volatile persons, handling prescription drugs, and working late hours at night. Workplace violence occurs in every healthcare setting, but there are some areas at higher risk of WPV such as mental health units, and the Emergency Department (ED). Health care workers in the ED are at risk for WPV and are routinely exposed to WPV from patients and their families/friends.

Aim of the study: The aim of this study is to explore the WPV among the ED nurses and doctors in the Kingdom of Saudi Arabia (KSA).

Method: A correlational quantitative cross sectional design was used to collect data from six public hospitals in the KSA by utilizing an anonymous self-administered questionnaire.

Result: A total of 288 ED nurses and doctors participated ,73 (25.7%) participants were subjected to physical assault, 76 (27.2%) to physical threat, 196 (69.8%) to verbal abuse, and 47 (17.3%) to sexual harassment. Patients’ families/friends were the main source of WPV. Male patients or patients’ families/friends were the most common source of WPV for physical assault, physical threat and sexual harassment, except for verbal abuse were both genders were involved equally. Most of the participants (n=220; 78.9%) agreed they are vulnerable to WPV and 198 (69.7%) agreed that WPV affects their professional performance.  Furthermore, most of the participants (n=117; 41.5%) indicated that they are not sure if they could manage WPV and 230 (82.7%) have indicated that they need training/more training in dealing with WPV. Participants reported that an increase in the number and the quality of the security staff, improving the patient admission process, and educating the public about when to use the ED would reduce the WPV in the ED. In addition, there was a significant relationship between the prevalence of physical assault and the absence of WPV prevention training (p=0.040). Furthermore, there was a significant difference in the perception of participants regarding the acceptance of WPV as a part of the job and the job of the participants. Nurses were found to be more accepting of WPV more than doctors (p=0.019).

Conclusion: Workplace violence is prevalent among the ED nurses and doctors in the KSA especially verbal abuse. The findings are congruent with the existing literature however the recommendations for policy practice education and research need to be consistent with Saudi Culture and cognisant of the multicultural workforce. The utilisation of the findings for development of a WPV prevention policy in ED is recommended for further research.

Biography

I am a PhD candidate studying at Monash university. Right now, I am doing my PhD in Nursing as full time and fully sponsored by the Saudi government. I worked in the emergency department of two tertiary hospitals in the Kingdom of Saudi Arabia for more than 8 years. Furthermore, I worked in different areas in the ED. since I started doing my master, I focused on the management issues that prevent the ED nurses from providing their optimal care in the proper manner such as occupational stress and workplace violence. I believe that there is a chance for us as nurses to change the current situation by disseminating our research findings and that hope will change the current situation for a better one.

Use of protective lung strategies in the management of mechanically ventilated adult emergency department patients: A cross sectional survey

Sarah Cornish1, Rochelle Wynne2, Sharon Klim3, Anne-Maree Kelly4

1 Sunshine Hospital. 176 Furlong Road, St. Albans, VIC 3021, sarah.cornish@wh.org.au
2 School of Health Sciences, University of Melbourne, Parkville, VIC 3010.
3 Joseph Epstein Centre for Emergency Medicine Research, Sunshine Hospital. 176 Furlong Road, St. Albans, VIC 3021
4 Joseph Epstein Centre for Emergency Medicine Research, Sunshine Hospital. 176 Furlong Road, St. Albans, VIC 3021

Background: Mechanical ventilation (MV) is a therapeutic intervention used in emergency departments (EDs) that has associated complications such as lung trauma and the development of acute respiratory distress syndrome (ARDS). In the last decade there has been increasing interest in the use of protective lung strategies (PLS), comprised of low tidal volume (6mL/kg) delivery, control of fraction of inspired oxygen and plateau pressures, and administration of positive end expiratory pressure (PEEP) to reduce risks associated with MV. Australian ED nurses share ventilation decision-making with their medical colleagues. However, there is very little evidence describing nurses’ knowledge or application of PLS. The aim of this research was to determine clinical practice patterns and nurses knowledge regarding the implementation of PLS in the ED.

Methods: The study used a descriptive, exploratory design and online questionnaire. A convenience sample was recruited via the College of Emergency Nursing Australasia mailing list and snowball sampling. A three-part questionnaire was designed to identify demographic data, information on clinical practice patterns and nursing knowledge of PLS via validated case scenarios.

Results: The survey was completed by 157 nurses and PLS are being used in many EDs (n = 104, 75%). Clinical practice guidelines for mechanical ventilation were accessible to 62% (n =86) of participants. Formal tools are used by many clinicians to determine optimal tidal volume (n = 112, 80%). Nurses knowledge of PLS was sound and components of decision-making in relation to PLS consistent, however level of confidence and perceived autonomy when implementing PLS in the ED varied.

Conclusion: PLS are being used in Australian EDs in the clinical care of mechanically ventilated patients, which aligns with best available evidence. Australian ED nursing staff have good levels of knowledge of this approach to MV. There is a need for standardised evidence-based clinical practice guidelines that may improve nurses’ confidence in implementing such strategies, and also provide a benchmark for future clinical practice to facilitate the generation of evidence on this topic. Development of such a guideline may pave the way for ED nurses to independently manage invasively ventilated patients which presents an innovative approach to care delivery of these highly complex patients.

Biography

Sarah Cornish has been a passionate ED nurse for over 14 years and is working in the dual roles of Clinical Nurse Educator and Clinical Nurse Specialist in the ED at Sunshine Hospital, Melbourne, Victoria. Sarah has recently finished her Masters in Advanced Nursing Practice, by Minor Thesis, and has a particular interest for mechanical ventilation in the ED. Sarah was also awarded the honour of being the CENA Emergency Nurse of the Year in 2015.

Understanding reasons for Emergency Department (ED) attendance in a metropolitan hospital

Jo-Anne McShane1, Andrew Maclean1, Julie Considine2

1 Emergency Department, Box Hill Hospital, Eastern Health, Victoria, Australia
2 Eastern Health – Deakin University Nursing and Midwifery Research Centre

Background
Our Emergency Department (ED) is located in a health service with three acute care sites and three ED’s. Following an above expected rise in presentations to one specific ED within the health service (16% in 12 months), we decided to look at why patients chose to present to our ED and the decision making process around their presentation.
Methods
This was a single-site cross-sectional study of patients (n=200) who were triaged to the main waiting room and fast-track waiting room (ATS 3-5) over a six week period from October- December 2015.
Patients were asked about:
• Their perception of the seriousness of their condition before ED arrival and while they were waiting (1=not serious at all to 10=serious).
• Their perception of the urgency of their condition before ED arrival and while they were waiting (1=not urgent at all to 10= serious).
• Factors considered prior to attending the ED.
• General perceptions and attitudes towards ED services.

Results
When making the decision to come to hospital patients rated their perception of the seriousness of their condition, with 52% rating themselves moderate to high (score 4-7), slightly increasing to 57.5% after arriving in the ED. A majority of patients (62%) rated themselves with the same level of seriousness pre and post presentation.

The perceived level of urgency at the time of making the decision to come to ED was 45%, (score 4-7) increasing to 51.5% after arriving in the ED. A majority of patients (68%) rated themselves the same level of urgency pre and post presentation.

There were many factors patients considered when presenting to the ED. Patients strongly felt that the hospital provided better care for their condition (59%), found it convenient to have all services in one place (55%), with the hospital being close by to where they live (58%). When deciding to attend the ED a majority of patients did not take into consideration the financial impact (68%) or issues around privacy (98.5%).
Patients had strong feelings in regards to general perceptions and attitudes towards ED services. Patients believed that people should only come to hospital if their illness is urgent or life threating (63%), with a majority of people saying that coming to the hospital for non-urgent illnesses was a misuse of the system (68%). Most patients felt that hospitals had the convenience of all facilities in one place (92%) and were willing to wait even if the ED was crowded (52.5%). They believed that hospital doctors and nurses are better specialised (63%) and even if they presented to a GP they would be referred to the hospital anyway (59.5%).
Conclusion
Patients present to the ED because they believe their condition is serious and urgent enough to warrant emergency care.

Biography

Jo-Anne is a Research Nurse and Clinical Nurse Specialist with over 16yrs experience in various Emergency Departments in Australia and overseas.

Under the radar or beyond the horizon? Aeromedical retrieval in Central Australia

David Carpenter1

1 David Carpenter BNurs, GradDip Nurs (Emerg), GradDip Mid.

Royal Flying Doctor Service (Central Operations), PO Box 2210  Alice Springs NT 0871 david.carpenter@flyingdoctor.net

The Royal Flying Doctor Service of Australia (RFDS) is one of the largest and most comprehensive aeromedical organisations in the world. Staff at the Alice Springs base provide emergency medical evacuations for people who live, work and travel in remote Central Australia, many of whom have a heavy chronic disease burden.  The vast distances, climatic extremes, cultural diversity and wide spectrum of clinical presentations combine to provide a unique practice setting with a birds-eye view.

This presentation outlines the influence that each of these factors has on aeromedical operations in the region, before exploring the development of innovative solutions that support the provision of safe and efficient aeromedical transport across a region the size of Western Europe. These include partnerships with the Alice Springs Hospital Retrieval Service and Central Australian Remote Health, along with a unique 7-tier priority coding system for tasks. The presentation will also incorporate the use of interactive technology to poll the audience for their answers to scenario-based questions in real time.

Biography

David Carpenter is Tasmanian born and bred, and worked as an Emergency Nurse in Launceston for a number of years. After a short period as a locum Remote Area Nurse in 2008, David qualified as a Midwife and swapped temperate island life for the vast deserts of Central Australia. He has worked as an Alice Springs-based Flight Nurse/Midwife with the RFDS since 2011.

Transplanting emergency nursing: Can lessons from Australian emergency nursing make a difference in Indonesia?

Putu Budiarsana1

1 Rumah Sakit Umum Pusat Sanglah, Jalan Diponogoro Denpasar, Bali, Indonesia, budiarsana79@gmail.com

Emergency departments around the world face similar challenges in such as increasing acuity and overcrowding due to bed block. Emergency departments in developing countries face additional challenges such as limited resources and problems associated with professional status and the development of collaborative working relationships.

Indonesia has recently introduced universal health coverage which has resulted in unprecedented pressure on public hospitals. As a major teaching and referral hospital Sanglah Hospital in Bali has been particularly affected by these changes, with up to sixty admitted patients at one time waiting in the emergency department for transfer to wards.

This paper describes a collaborative improvement project conducted jointly between nurses from Darwin and nurses in Bali to assist in improving patient flow. Using the Practice Change Framework for International Development (Brown, 2011) this paper describes the process for designing and implementing patient flow ideas from Australia to improve the quality of emergency care at Sanglah Hospital. The challenges and results of implementing reforms in such a challenging environment are explored.

Biography

Pak Budi is the Nurse Coordinator for the Emergency Department at Sanlgah Hospital, Bali, Indonesia. He has also nursed in Australia and completed postgraduate studies in Adelaide.

The why and how of introducing a waiting room nurse role into the Emergency Department

Kelli Innes1,3, Professor Doug Elliott1, Professor Debra Jackson2, Associate Professor Virginia Plummer3, 4

1 University of Technology Sydney, 15 Broadway, Ultimo, N.S.W., 2007, kelli.innes@monash.edu
2 Oxford University Hospitals NHS Foundation Trust, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Hill Oxford, U.K., OX3 OFL.
3 Monash University Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, McMahons Road Frankston, Vic. 3199
4 Peninsula Health, Hastings Road Frankston, Australia 3199.

Introduction: Multiple factors, including increasing patient presentations and access block, are placing emergency departments (EDs) under increasing pressure. As a result waiting times are increasing, patient outcomes are compromised and EDs find meeting key performance indicators challenging. To improve patient care, transition and flow, some emergency departments (EDs) have introduced a waiting room nurse role, to enhance patient safety by commencing care early, identifying deteriorating patients and improving communication between patients and staff. There is however limited published literature on the benefits, challenges and effectiveness of this role. The aim of this research was to identify why and how the waiting room nurse was initially introduced into Australian EDs.

Method: Semi-structured interviews with five key informants were conducted (data saturation achieved), and supported by analysis of related government and health service documents, to identify and explore the rationale for development of the role and subsequent implementation.

Results: The role was primarily implemented to improve quality of care and decrease the potential for clinical risk for patients in the ED waiting room. The primary aim was to decrease waiting times by commencing interventions early, reassessing patients more frequently and improving communication with patients, relatives and the multidisciplinary team in the ED. Practice was commonly underpinned by standing orders. Education and preparation was not standardised, with nurses in the role having varied backgrounds and levels of experience. There was limited evaluation of the role noted by the key informants. Document analysis supported the findings of the key informant interviews.

Discussion: Although the waiting room nurse role was primarily developed to improve outcomes and safety, and decrease clinical risk, it remains unclear what the benefits and effectiveness of the position have been, given the limited evaluation. These findings supported the available literature that the scope of practice was commonly defined by standing orders, and preparation and education of nurses varied. Further evaluation of the role is recommended, to inform some standardisation in preparation and practice.

Biography

Kelli has an extensive background in emergency nursing and education. Currently a lecturer at Monash University where she teaches into the postgraduate emergency nursing stream and the undergraduate nursing program. She is also a PhD candidate at The University of Technology Sydney where she is evaluating the emergency department waiting room nurse role.

The Case Reflection Emergency Master Class

Melissa Hanson1, Kerralyn Buckman2, Judy Townsend3

1 Dubbo Base Hospital, Myall Street, Dubbo, N.S.W., 2830, Melissa.Hanson@health.nsw.gov.au
2 Dubbo Base Hospital, Myall Street, Dubbo, N.S.W., 2830, Kerralyn75@gmail.com
3 Dubbo Base Hospital, Myall Street, Dubbo, N.S.W., 2830, Judytownsend_60@hotmail.com

Reflection is an important facet of nursing, because it helps us as nursing professionals to analyse and evaluate our practice. It helps us to recognise those elements of excellent service provision, as well as areas for improvement. It provides for a wider scope of learning from these experiences. It is through this reflection that we as Emergency Nurses aim to continually improve the professional standards of nursing in our Australian Emergency Departments (ED).

The Case Reflection Emergency Master Class was developed for the Dubbo Base Hospital ED nursing employees in response to the need for reflection and education opportunities. It was designed to provide additional education and service improvement prospects within the Dubbo rural area, and further aims to expand these prospects to Dubbo’s outlying rural and remote peripheral services – the Western New South Wales Local Health District (WNSWLHD) – in view of its continuing success. The Case Reflection Emergency Master Class is an innovative model of education designed to maintain and enhance nursing knowledge and skills.

As nursing employees within the WNSWLHD, we know it can be difficult to access and participate in education and simulation-based learning opportunities due to a myriad of multi-faceted issues. Distance and isolation are all too real; resources are limited; and being able to get time off in order to attend education is often difficult due to a lack of staff in the first place. Most of the education and travelling involved are undertaken in nurses’ own time, and at their own expense.

That is where the Case Reflection Emergency Master Class steps in. Dubbed “Master Class” for short, it is Dubbo Base Hospital ED’s analysis session focussed on education and reflection. It involves the discussion of important cases that we see in our department – we talk about what we did well; what we can learn from; the background and patho-physiology of the case, and more. Think along the lines of a Morbidity and Mortality Meeting, only less formal, less confronting for nursing staff, and more targeted to nursing knowledge and performance.

The main aims of the Master Class are to:

  • Identify areas of strength, as well as areas of need;
  • Enable additional ED skill acquisition;
  • Improve clinical competency and confidence amongst ED nursing staff, and therefore as a result;
  • Improve health-based outcomes for all our patients.

The added benefit of this form of education is that we can review and learn about presentations that are classified as infrequent in nature. These types of presentations, for example, a major trauma or a paediatric cardiac arrest, require advanced skills and knowledge that may not be fully utilised regularly by nursing staff in rural and remote areas. The Master Class gives ED nurses the opportunity to learn and develop these skills, and practice them in a simulation-based environment without having to travel great distances, pay a great deal of money, and take significant time off work.

Biography

Melissa Hanson is an Advanced Clinical Nurse and the acting Clinical Nurse Educator in the Emergency Department of Dubbo Base Hospital. She has 5 years of experience in Emergency Departments within metropolitan and rural New South Wales. When she is not living and breathing emergency nursing, you’ll find her being a mum to her 3 babies aged 4 and under, baby-wearing one of her babies, or out on the family farm trying her hand at country life!